{ "resourceType" : "PlanDefinition", "id" : "CXCAD18SRecallScheduling", "meta" : { "profile" : ["http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"] }, "text" : { "status" : "extensions", "div" : "
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Id: CXCAD18SRecallScheduling
Url: CXCA.D18.S — Recall Scheduling
Version: 0.0.1
Title: CXCA.D18.S — Recall Scheduling
Status: draft
Type: \n \n \n \n

\n system: http://terminology.hl7.org/CodeSystem/plan-definition-type\n

\n \n \n

\n code: eca-rule\n

\n \n \n \n \n \n
Date: 2026-05-14 00:50:23+0000
Publisher: Dan Heslinga (independent contributor)
Description:

Decision support for recall and re-call per Mongolia MOH Order A/641 (2020) section 2.3. Evaluates seven timeout triggers (HPV sample timeout, positive-result follow-up timeout, biopsy timeout, treatment-after-biopsy timeout, cytology unread timeout, second-reminder, missed scheduled exam) and instantiates a CommunicationRequest reminder for each fired trigger. The 187 LTFU women from the April 2026 Khan-Uul pilot represent the empirical case for why this layer matters — DE39 (positive-result follow-up timeout, 4 weeks) is the trigger that should fire for each of them.

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Libraries: \n \n \n \n \n \n \n
CXCAD18SRecallSchedulingLogic
\n
Actions: \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n
\n \n Recall — HPV sample result missing more than 3 weeks: An HPV sample was dispatched more than 3 weeks ago and no result has been entered. Issue a reminder to follow up with the lab.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — HPV sample result timeout)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — positive screening result without follow-up exam after 4 weeks: A positive screening result was entered more than 4 weeks ago and no follow-up examination has been recorded. Issue a reminder to the patient and the clinician. THIS IS THE LTFU-PREVENTION TRIGGER — the 187 women lost to follow-up in the April 2026 Khan-Uul pilot would each have had this trigger fire.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — positive result follow-up timeout)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — biopsy result missing more than 4 weeks: A biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Follow up with the lab.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — biopsy result timeout)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — no treatment record more than 4 weeks after positive biopsy: A positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Issue a reminder to schedule treatment.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — treatment after positive biopsy timeout)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — cytology slide unread more than 2 weeks at lab: A cytology slide was received more than 2 weeks ago and no cytologist conclusion has been entered. Follow up with the lab.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — cytology slide unread timeout)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — second reminder needed (first sent more than 4 weeks ago): A first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Issue a second reminder.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — second reminder needed)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n \n Recall — missed scheduled examination: Patient missed a scheduled examination. Immediate reminder — no timeout wait.\n \n
\n \n \n If:\n \n Applicability:\n \n (Recall — missed scheduled examination)\n
\n \n \n \n \n Then: Definition: CXCAD18 — Recall Reminder CommunicationRequest
\n \n \n \n
\n
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\n
" }, "contained" : [{ "resourceType" : "Library", "id" : "effective-data-requirements", "extension" : [{ "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — treatment after positive biopsy timeout" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE41 \"Recall: treatment timeout after positive biopsy (4 weeks)\"\n */\ndefine \"Recall — treatment after positive biopsy timeout\":\n \"TreatmentAfterPositiveBiopsyTimedOut\"" }, { "url" : "displaySequence", "valueInteger" : 0 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — HPV sample result timeout" }, { "url" : "statement", "valueString" : "// =============================================================================\n// Recall trigger rules — one per A/641 section 2.3 timeout\n// =============================================================================\n\n/*\n * @output: CXCA.D#DE38 \"Recall: HPV sample result timeout (3 weeks)\"\n */\ndefine \"Recall — HPV sample result timeout\":\n \"HPVSampleResultTimedOut\"" }, { "url" : "displaySequence", "valueInteger" : 1 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — positive result follow-up timeout" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE39 \"Recall: positive result follow-up timeout (4 weeks)\"\n * The single most important trigger — fires for the LTFU population from\n * the April 2026 Khan-Uul pilot.\n */\ndefine \"Recall — positive result follow-up timeout\":\n \"PositiveResultFollowUpTimedOut\"" }, { "url" : "displaySequence", "valueInteger" : 2 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — biopsy result timeout" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE40 \"Recall: biopsy result timeout (4 weeks)\"\n */\ndefine \"Recall — biopsy result timeout\":\n \"BiopsyResultTimedOut\"" }, { "url" : "displaySequence", "valueInteger" : 3 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — missed scheduled examination" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE44 \"Recall: missed scheduled examination\"\n * No timeout — fires immediately once a missed appointment is detected.\n */\ndefine \"Recall — missed scheduled examination\":\n \"MissedScheduledExamination\"" }, { "url" : "displaySequence", "valueInteger" : 4 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — cytology slide unread timeout" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE42 \"Recall: cytology slide unread timeout (2 weeks)\"\n */\ndefine \"Recall — cytology slide unread timeout\":\n \"CytologySlideUnreadTimedOut\"" }, { "url" : "displaySequence", "valueInteger" : 5 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD18SRecallSchedulingLogic" }, { "url" : "name", "valueString" : "Recall — second reminder needed" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE43 \"Recall: second reminder (4 weeks after first)\"\n */\ndefine \"Recall — second reminder needed\":\n \"FirstReminderUnresolvedAtSecondTimeout\"" }, { "url" : "displaySequence", "valueInteger" : 6 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }], "name" : "EffectiveDataRequirements", "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/library-type", "code" : "module-definition" }] }, "relatedArtifact" : [{ "type" : "depends-on", "display" : "FHIR model information", "resource" : "http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1" }], "parameter" : [{ "name" : "TreatmentAfterPositiveBiopsyTimedOut", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "HPVSampleResultTimedOut", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "PositiveResultFollowUpTimedOut", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "BiopsyResultTimedOut", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "MissedScheduledExamination", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "CytologySlideUnreadTimedOut", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "FirstReminderUnresolvedAtSecondTimeout", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — treatment after positive biopsy timeout", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — HPV sample result timeout", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — positive result follow-up timeout", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — biopsy result timeout", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — missed scheduled examination", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — cytology slide unread timeout", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Recall — second reminder needed", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }] }], "extension" : [{ "url" : "http://smart.who.int/cxca/StructureDefinition/cxca-bindingness", "valueCoding" : { "system" : "http://smart.who.int/cxca/CodeSystem/CXCA.Bindingness", "code" : "legal", "display" : "Legal — binding regulatory instrument" } }, { "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements", "valueCanonical" : "#effective-data-requirements" }], "url" : "http://smart.who.int/cxca/PlanDefinition/CXCAD18SRecallScheduling", "version" : "0.0.1", "name" : "CXCAD18SRecallScheduling", "title" : "CXCA.D18.S — Recall Scheduling", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type", "code" : "eca-rule" }] }, "status" : "draft", "experimental" : false, "date" : "2026-05-14T00:50:23+00:00", "publisher" : "Dan Heslinga (independent contributor)", "contact" : [{ "name" : "Dan Heslinga (independent contributor)", "telecom" : [{ "system" : "url", "value" : "https://github.com/dhes" }] }], "description" : "Decision support for recall and re-call per Mongolia MOH Order A/641 (2020) section 2.3. Evaluates seven timeout triggers (HPV sample timeout, positive-result follow-up timeout, biopsy timeout, treatment-after-biopsy timeout, cytology unread timeout, second-reminder, missed scheduled exam) and instantiates a CommunicationRequest reminder for each fired trigger. The 187 LTFU women from the April 2026 Khan-Uul pilot represent the empirical case for why this layer matters — DE39 (positive-result follow-up timeout, 4 weeks) is the trigger that should fire for each of them.", "library" : ["http://smart.who.int/cxca/Library/CXCAD18SRecallSchedulingLogic"], "action" : [{ "title" : "Recall — HPV sample result missing more than 3 weeks", "description" : "An HPV sample was dispatched more than 3 weeks ago and no result has been entered. Issue a reminder to follow up with the lab.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — HPV sample result timeout" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — positive screening result without follow-up exam after 4 weeks", "description" : "A positive screening result was entered more than 4 weeks ago and no follow-up examination has been recorded. Issue a reminder to the patient and the clinician. THIS IS THE LTFU-PREVENTION TRIGGER — the 187 women lost to follow-up in the April 2026 Khan-Uul pilot would each have had this trigger fire.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — positive result follow-up timeout" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — biopsy result missing more than 4 weeks", "description" : "A biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Follow up with the lab.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — biopsy result timeout" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — no treatment record more than 4 weeks after positive biopsy", "description" : "A positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Issue a reminder to schedule treatment.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — treatment after positive biopsy timeout" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — cytology slide unread more than 2 weeks at lab", "description" : "A cytology slide was received more than 2 weeks ago and no cytologist conclusion has been entered. Follow up with the lab.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — cytology slide unread timeout" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — second reminder needed (first sent more than 4 weeks ago)", "description" : "A first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Issue a second reminder.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — second reminder needed" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }, { "title" : "Recall — missed scheduled examination", "description" : "Patient missed a scheduled examination. Immediate reminder — no timeout wait.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Recall — missed scheduled examination" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest" }] }